Pain in avulsion lesions of the brachial plexus

Traction lesions of the brachial plexus are becoming more frequent. Many of the lesions involve avulsion of nerve roots from the spinal cord. This very often results in severe pain which is associated with deafferentation. Although reference to this pain and the difficulty in its management has been made in several reports in the literature, there has been no long-term study of the natural history of this pain and the effects of various attempts to mitigate it. This series reports on a long-term follow-up of 275 patients of which is 108 had evidence of avulsion lestions. Of these 108, 98 suffered significant pain. There is a remarkably constant description of the pain and the various activities that may affect it. Drugs are of very limited use and the most valuable method of treatment found in this series was transcutaneous electrical stimulation--although, only one-third responded dramatically to this treatment. The single most effective manoeuvre that reduces pain is absorption by the patient in work. There remains a significant number of young men with severe pain who may expect to suffer such pain indefinitely. There is urgent need for new methods to be developed to control this pain.